Addiction, Alcoholism, Gastric Bypass Surgery, Nutrient Deficiency and the Brain

In my last blog, I wrote about how they recently showed that gastric bypass surgery significantly increased your risk of developing alcoholism and substance abuse as well as suicide attempt and depression, much more so than merely restrictive procedures such as the lap-band.

Early on this was attributed to a psychological phenomena they called addiction transfer – theorizing that once a food addict could no longer eat they would “switch” to another substance in order to feel good.   It seemed to make sense.   Except to those of us who were experiencing it.  We knew things were different.   We felt “different”, “wrong”.  If this were truly psychological, we should see similar rates of this transfer among all weight loss surgeries:   duodenal switch, sleeve gastrectomy, lap-band, etc.

Many chemicals in the brain are responsible for that sense of well-being, your ability to feel happiness:  serotonin, dopamine, norepinephrine, endorphins.   But what about all the other nutrients your body must have in order for these chemicals to function properly?  They all work together.  Now what if those nutrients started to slowly diminish over time?  Say over the next 12-14 months? And longer?  How would you feel then?

What if you’ve suddenly achieved something you’ve yearned for, perhaps your entire life, and now find yourself having difficulty finding pleasure in things you know should find pleasure in?   Trying on new clothes?   Meeting new people?   Peoples reaction to the new you?   And what if that ability experience pleasure and joy just is not there.   You know it should be and it isn’t.   What if you start having trouble sleeping, maybe having anxiety, and you have no idea why?

And then you experience something and you feel “good” for the first time in a long time.   Maybe that something is alcohol, which if you’ve had gastric bypass, even a little bit might feel really good where before it was no big deal.   Or maybe your doctor writes you a prescription and you pop that pill and feel “good” again.  Or it might be shopping, etc…..   Or maybe you’re just one of those people that just tough it out and slog through and continue to feel awful.   The brain is incredibly amazing at associating what you need to not feel awful and is very crafty and effective at convincing you to keep it from feeling like crud all the time.

But I’m convinced that if the “feel good” chemicals in the brain had not been so deteroriated by the many months and months of depletion, so many people would not have vulnerable in the first place to this scenario.     There seems to be more understanding about how addiction works these days – the pleasure/reward pathways.   What I am hoping the scientific community starts to explore is where the breakdown is occuring.   How is this surgery creating the bio-chemical changes in our bodies that make a signficant population more vulnerable to addiction?

If this sounds at all familiar to your story, let me know.

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20 Comments

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20 responses to “Addiction, Alcoholism, Gastric Bypass Surgery, Nutrient Deficiency and the Brain

  1. Thank you so much for this. I found a link to your blog in a post you wrote on obesityhelp.com. I’ll send you my story when I have a little more time to write. For now, I just wanted to say thanks. Maybe I’m not losing my mind after all. 🙂

  2. WOW!!! Wish I would have seen this in 2004 when I had my bypass surgery. Would have maybe saved me about $60,000 since 2008 attending 2 rehabs. Just got out of my second one 3 days ago. My first addiction after almost dying from my bypass from a leak, was opiate. My $90k pharmacy bill when I was in the hospital for 3 weeks after my original surgery, jumped started my opiate addiction. Got that under control with Suboxone, then moved on to shopping. Maxed out the credit cards, and then moved to Alcohol. I could drink totally normal until 2008. A glass of wine maybe once a month. No worries. Then I had twins, think my chemistry was off/had a bit of post partium depression and bam…was drinking a huge bottle of vodka a day about 3 months later. 3 more months, went to the first rehab. Was clean for almost 2 years and relapsed. Drank like a rock star for about a month and then went and go a Vivitrol shot (heaven sent medication..pricey, but SO worth it IMO). Stopped drinking. White knuckled it until the end of last year, so made it about 2 year sober and then started working for a crazy lady, it was mayhem at home and had a department of almost 30 people reporting up through me. I got addicted to staying up all night because of the peace and quiet. I would start to get that tweaky feeling you get with sleep deprevation and got addicted to that (WTF?? Only a true addict would get something like that, I”m sure!). Could only do that naturally for a few months, and then discovered Adderall. Took about 18 30mg pills a day for about 3 months (normal dose is 2/day), then back to rehab. I must say that I love my new body and the way clothes fit, etc…even though I’m an addict and alcoholic, I would most likely have the surgery again if I could turn back time. I would just have been an educated patient and have dealt with the emotional baggage that had me eating, drugging and drinking BEFORE hand. Obviously, people are eating themselves to death for a reason (in most cases)…hence the need for the surgery.to lose weight. Unfortunately, people don’t really think that addiction is more than will power (weather it is food, sex, drugs, shopping, etc…). There is scientific proof (isolated genes for alcoholism) that this is a disease, but people haven’t gotten word about that. We are just weak people with no will power. I’ll save that for another post though :). I love this thread though. It has opened my eyes to the fact that I don’t just need environmental (ie: no drink or drug substances) and emotional sobriety (ie: dealing with some childhood stuff), but I need PHYSICAL sobriety as well. I take my daily vitamin, do B12 nasal spray, and take iron here and there, but I’m wondering if I’m deficient anywhere else. This brings up a question:
    I have my yearly blood work. I’m always low on my B12 and Iron. Is there testing that I need to have beyond these yearly blood tests? In other words, just because these are coming back in the normal range, could these be invalid? Or, do I need to ask for specific testing to be done, above and beyond the normal one…if so, what is that called?

    I live in Dallas, but am willing to fork out some more of my savings to go to the Bodhi place if needed. I would obviously prefer to find a place here local, so would appreciate any info on the testing if you could provide it, and I will see if I could find a doctor here to treat me. Can’t hurt to get the push to see if it brings me some joy. Since that seemed to be ripped out of me the second I woke up from that surgery. Would love to just find joy in being with my 3 beautiful kids, instead of having to search for joy in a pill or a store. 😦

    Thanks for taking the time to post this thread. It is great info, and even if it isn’t an answer for me, at least it comforting to know I’m not losing my mind and am alone in feeling this way.

    Take care
    Lisa

    • What caught me in your post (thank you so much for sharing) is that you would love to find joy in your beautiful kids rather than seeking a pill or a store. That to me sounds like there may still be cause for concern. Rehab, Suboxone, Vivitrol can all be excellent medical tools for breaking an addiction to a particular substance but I feel if you don’t address what drove you to the addiction in the first place you’ll be bouncing from one to the other desperate to find some relief.

      Unfortunately lab tests for nutrients tend to be somewhat limited (at least the ones that are typically run and some serum tests aren’t necessarily indicative of a tissue deficiency – magnesium and calcium for example). The labs do seem to pick up folate, B-12 and anemia but you also need to be aware of the optimum value for you rather than being within the labs “normal” range. I have also seen they can test for B1, B6, zinc and copper but those aren’t always done so you may have to be a ‘nudge’ and ask. There is a tissue test for magnesium (EXAtest) but you would need to ask for it specifically.

      Was the inability to find joy in everyday activites something that you experienced pre-surgery or post-surgery? Did you have Roux-en-Y? Do you recall about when you started abusing substances and why? How soon after surgery? My point being to try and associate a certain uncomfortable feeling that you medicated. If you think that may be the case, it may actually be difficult to pinpoint exactly which one because it may very well be deficiencies in multiple nutrients and micro-nutrients. I don’t think you need to leave Dallas though – you should have access to Naturopathic doctors or orthomolecular doctors. I have no affiliation with Bodhi and merely used it as an example.

      Good luck to you an I hope you let me know how you are doing.

      • You are right on with your response about getting to the root of the problem. I have spent many many hours thinking what the root cause was with making me want to take a “chemical vacation”, as I call my using. I don’t feel like I’m safe to be me when I’m at home. I feel as if I don’t be a certain way, or don’t say something right, I will negatively impact the emotional “thermostat” in the house. I don’t know how to release my feelings in a healthy way, so I implode and use to escape reality. The main men who impact my life go the other way and explode. I’ve been worling with counselors to operate in the middle like most other people. I have also started medication to treat my bipolar ways. To your point, I believe there are 3 areas that are critical to long term sobriety: Chemical Sobriety (don’t use drugs or drink), Emotional Sobriety (deal with emotions in a health way, figure out what is missing, why you are doing this, etc… – VERY hard journey, but worth the effort and energy), and Environmental Sobriety (are your relationships healthy and equal in give and take? Do you like your job? Is your home secure, do you fell safe to just be you in your house). Lot’s of hard questions, lots of hard answers, but I feel that I have to make something good out of this past hellish few years. I needed a cure because the treatments weren’t working and needed the best chance going forward.

        The nutritional component falls under the Chemical Sobriety part for me. I’ve had some initial testing and nothing outside of the norm was found. I talked to an old family friend and she went through the same thing. Her research found that the “norms” that they are using for nutritional ranges are mostly ones determined in the 1970’s!! She researched and hunted down a doctor who was able to put together all of her symptoms that 15 other doctors couldn’t find a similar link between (ie: cold hands, hair loss, crying, dry skin, etc…) Here hormones were way way out of balance according to their newly calculated ranges that are based on many demographics of a specific person, not a societal generality. The key to all of this in my opinion is that you need to be educated, ask questions and if something doesn’t sit right, find another doctor or professional who can help and post your story and ask others the same questions you would a doctor. Just like you did, here. Thanks for your posting and response. Sounds like you might have hit on something that would be worth your further efforts to research, as you suggest. In my opinion, you will help many people and lead them to the door to help. Unfortunately, that is as far as anyone can get us, the journey is ours to walk alone, with the encouragement and love from others in our hearts and hopefully they are still there waiting for us at the end of the one journey to start the new journey of being in “remission from addiction” (I like that term better than “recovery”. I don’t think you ever actual recover and are cured, you just keep the demons at bay). My 2 cents anyway.

    • What a lovely posting . It appears as if there was been a great deal of progress in between comments based on the insights you write about. I agree with you and I’m happy you are getting treatment for the bi-polar and are continuing to identify and improve in other areas so that you can live a happy, healthy and peaceful life. Continued good wishes and I hope you let me know it’s going.

  3. Dorothy M. Jones

    Yes, sounds so familiar…..I had gastric bypass surgery in 1986 and have had major problems with iron absorption(have had to have infusions every two years since 1993)…Also, I did lose 85 lbs. but in these many years 50 have crept back on…It is so sad and depressing because I want desperately to lose the weight again and it is so hard. I drink wine almost every night which certainly doesn’t help with the weight loss and I know it is not healthy to drink several glasses of wine but yes, you are right, it makes me feel good!!! I wonder if there is a medication to “make me lose weight and not drink so much wine”.

    • Hello Dorothy, thank you for sharing. If you are deficient in iron and drinking you may want to consider you are also deficient in B-vitamins as well as magnesium and possibly other micro-nutrients.

      While you are building back up your reserves you could talk to a doctor about Topamax (or Zonagran) or Naltrexone. Topamax is actually an anti-epileptic drug but has shown some success in reduction in drinking and snacking and improved weight loss – it reduces the craving somehow. Naltrexone has shown some pretty good success by blocking the euphoria associated with drinking. However you have to take it and then drink for maximum effectiveness (according to Sinclair). It is available in injection form (Vivitrol) also and that appears to be more effective than the oral medication since some people decide to not take their Naltrexone if they wanted to actually enjoy their wine. This helps break that positive reinforcement associated with drinking.

      But I would definitely recommend a full lab workup and get a copy for yourself. Remember though that is not the end all and be all. Your doctor is not treating lab results but rather a person, so it should depend on how you are feeling. Sometimes when we’ve been feeling down and crappy for so long we forget what it is like to actually feel good – and that we should actually feel that way most of the time.

      Good luck and please let me know how you are doing.

  4. Linda

    Sadly, this is all too familiar for me. I’m very interested in following this research and staying up to date on it. My problems began around 18-24 months after my surgery. I am currently sober and grateful to have survived a hell that I had no idea could ever happen to me. Thanks for creating a blog and helping spread the word. We need to band together on this and do what we can. Regards, Linda

    • I absolutely agree – I appreciate your support. I am thinking about trying to collect some data on my own with the help of one of the researchers I contacted. Up until now everything has been anecdotal. I’ll keep everyone posted.

  5. Beanz

    Does this sound familiar? Unfortunately, yes. My wife had gastric bypass just over seven years ago and while she lost more than half her body weight, has been left with long-lasting, if not permanent, problems. She has experienced shopping addiction, opiate addiction, alcoholism, and now amphetamine addiction which lasted a year. Some of these episodes were shorter term than others, but all have resulted in the compounding problems of addiction including financial distress, health issues, interpersonal strife and long-lasting, if not permanent, psychological ramifications. Thank you for writing about this. It’s changed my whole perspective.

  6. I’m so thankful that you’re started this blog. I really have found it amazingly helpful. I had Roux en-y 6 years ago and lost 170lbs. I’ve gained back 50, but still look decent, but I’m teetering on the edge. I noticed the alcohol change immediately, in the way my body reacted to it. I moved to New York after I lost all the weight. Started a new life. Half of New Yorkers are alcoholics anyway. This is drinking town. Was going out with friends every other night, but it was controlled. I didn’t get drunk every night. I never drank alone nor was I addicted per se, until about 2 years ago, when I started drinking at home alone to calm my nerves, which has spiraled down to 2-3 bottles of wine a night, every night.

    I have a few days here and there where I’m okay, but pretty much I’m drunk every night, and I can tell you, I don’t think it’s addiction transfer either. I think something physical has happened to me. Like a chemical switch in my body.

    I’m working on finding a way to quit. Trying to figure out the best way. Go see my doctor? Can’t do the inpatient thing, but am thinking of either AA or an outpatient treatment place. The problem is, none of those other people are dealing with this particular complication. That this is a complication from surgery. That’s what I think it is. Because I wasn’t like this before. I never, ever had a drinking problem before.

    Anyway, thanks for sharing your struggle and it’s great to know others out there are dealing with this too.

    • Linda

      Glad you found this info Rachael. I have met several people in treatment programs and the rooms of AA that have had this surgery. We are all slowly putting the pieces of this puzzle together – thankfully, there is now proof for what many of us already knew. I avoided inpatient treatment at first, tried outpatient and AA. I kept falling back into drinking though and eventually treated myself to the best 30 days away to put my sobriety first and foremost. Today, I attend AA on a regular basis. My gastric bypass isn’t a big part of what I share at meetings. How we all got to this point of becoming alcoholic, really doesn’t matter at the end of the day. We all recover from this thing the same way – gastric bypass or not. Path is different, solution is the same. I spent almost 2 years struggling trying to get sober “my way” and refusing to do inpatient – it didn’t work for me. Treatment was the best thing I ever did.

      Best wishes to you, I have been there, you don’t have to live this way, things will only get worse.

    • Thank you so much for writing to me Rachael. It’s nice to know that this information is helping people. Unfortunately the treatment models at most addiction centers haven’t progressed (most are 12-step based) and don’t really differentiate the treatment model for their gastric bypass patients that have flooded their intake centers. I remember trying to explain what was going on to the doctor at the center where my ex-husband went for treatment. It was all I could do to get them to give him a multi-vitamin and a B-12 shot. B-12 for alcoholics? What a novel concept. Most will heavily push AA if not require it. There are many different groups, so it’s important to find one that clicks for you if you decide to go the AA route. Just give it a try and decide if it’s right for you. But there are other recovery options and groups out there, so you’re not locked into AA – it’s just the most well-known and there are so many it will be easier to find them.

      Regardless of whether you go to AA, I think it’s a good idea to find an addiction doctor that you like, and one you feel comfortable talking with (it may take going to a couple of different ones), and who is open to you bringing him/her new information. Medications like Naltexone and the long-acting injection form of Naltexone called Vivitrol have shown promising results in easing the cravings. The Sinclair method uses Naltrexone and seems to have good results and actually requires that you drink normally – it removes the pleasure derived from drinking so that pleasure/reward connection is broken. Many American doctors don’t use it this way though, and you have to actually take the Naltrexone for it to work. That is why the Vivitrol has had better results. There is also a lesser known medication called Baclofen that has been shown to decrease cravings when used in higher doses. It has been around a long time and is generic and very inexpensive. Topamax is also frequently prescribed to reduce cravings. I don’t know if it is as effective as Naltrexone, but people often refer to it as ‘Dopamax’ because the side effects include making you feel foggy or stupid. You should be able to find help on an outpatient basis – in fact that is how most people do quit.

      I loved reading your post because you described the almost identical experience as so many others have.

      Doctors are hypothesizing that it is the fact that alcohol is so potent after the surgery that is causing the rise in all these addictions. But looking at your post, even though you experienced the increased effect early on, that wasn’t when the problem started. It sounds like you were a social drinker up until around two years ago when you suddenly started needing something to calm your nerves.

      While you are treating the acquired addiction, I hope you make sure you are renourishing your body so that you won’t find yourself needing something to treat symptoms of deficiency like anxiety and rapid heartbeat. Magnesium taurate or Magnesium chloride solution are both good, absorbable, and calming forms of magnesium. Brown rice protein in a shake is a good way to kick start your morning (especially for those that get sick from dairy or whey).

      You look great and I know you can do this! It must be great living in New York City. Please let me know how you are doing.

      Lisa

      • Thanks so much Lisa, for your great and informative response. I have made an appointment with a doctor who specializes in addiction, so I’m hoping that she will be very helpful and I will mention all the things you describe.

        It’s wonderful to be able to get help and information like this, knowing others have come through the other side of this struggle.

        Thanks so much!!

        Rachael

  7. Linda

    I guess I lucked out, my treatment center was well aware of the connection. The doctor was a certified addictionologist so maybe that is the key. They willingly gave me vitamins AND B12 shots. They even went out and bought the protein bars that I was using and offered to get whatever special foods I needed. I didn’t realize how lucky I was until I read what other’s have gone through at treatment centers. There were three of us in treatment at the same time and it was SO nice to be able to talk to others who could relate.

    Sometimes it is hard in AA because my story is so different, however I feel it’s important our voice be there to help those coming in. Many are not aware of the connection and they are so confused about what the heck happened to them. The program has given me much more than just a way to put down the drink. It gets to alot of the behaviors underneath my eating as well 🙂

    Our numbers are growing rapidly and I am so glad Lisa is willing to educate us and share information. I know several people working at treatment centers and I am continuing to keep them up to date on what I learn here. The topic is now coming up at addiction conventions here in Texas. I personally didn’t want to take a another drug to get sober, I felt like the meds that I was given for anxiety/depression only made things worse for me. Regardless of how we do it, best wishes to all who are lucky enough to survive this thing and find blogs such as this to help it all make sense. So thankful to have lived through that hell – hope we can continue to help others do the same!

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